Cervical Cytological Screening: A Case Study

Screening
Cervical cytological screening is accomplished by the Papanicolaou (Pap) smear screening test. Since this test was introduced in the 1970s, deaths resulting from cervical cancer have decreased by 71%.12 With this test, the patient is placed in the lithotomy position, and the provider inserts a speculum into the vaginal opening until the cervix and cervical os are visible. Then, the provider takes a cytological sample from the transformation zone of the cervix using a collection brush and spatula. 7, 22 The transformation zone is used because this is the area most vulnerable to cellular changes caused by an HPV infection.12 The specimens are then transferred to either a liquid preparation, ThinPrep being the most common, or directly
These organizations include ACOG, the American Cancer Society (ACS), the United States Preventative Services Task Force (USPSTF), the American Society for Clinical Pathology, and the American Society for Colposcopy and Cervical Pathology (ASCCP). However, in late 2012, these organizations released new guidelines that now support each other more consistently. These guidelines can be found in Table 2 of Appendix A.23, 24 It should be noted that all of these organizations agree that regardless of age of onset of sexual activity, patients should not be screened for cervical cancer until 21 years of age due to the slow-growing activity of cervical cancer and the high likelihood of the patient clearing any type of abnormality quickly on her own within 2 years. Also, these organizations recommend to cease screening after 65 years of age. However, all of these guidelines are followed when the patient has had no history of cervical cancer or abnormal screening. Once a patient becomes higher risk for developing cervical cancer, the healthcare provider must utilize screening modalities at different intervals.10, 24 With all of these guidelines, however, it has been shown that women who do develop cervical cancer are those who have not been screened regularly or who have not been screened in the past 5 years. This is a prime example of how important cervical cancer
The treatment of CIN can be divided into two different categories: ablative, or destructive, techniques and excision techniques. Ablative techniques include laser ablation, cold coagulation, and cryocautery of the dysplastic area. These techniques are used when the depth of a lesion is 5 mm at most. For lesions that are 10-15 mm thick, excision techniques are more suitable. A couple of the excision techniques are knife cone biopsies and laser excision, but the most common excision technique used in the treatment of CIN2 or CIN3 is loop electrosurgical excision procedure (LEEP).8 A LEEP consists of injecting local anesthesia into the transformation zone of the cervix, or in some cases sedation, followed by using a wire loop cautery unit that removes and cauterizes the area of concern. LEEP offers ease of use, low cost of use, minimal damage to the surrounding tissue, and low